Technology as Gateway to Knowledge

(This entry is also available as pdf download: see end of article for link.)

“Meaningful Use” is upon us. Hospitals around the country are scrambling to assess its implications which, aside from the obvious financial investment that must be made, will affect healthcare providers in other ways for many years to come. Since change is inevitable, this is the perfect time to look beyond the short-term aspirations of meaningful use, and identify what healthcare should look like into the future, maybe even as far as 20 years. The government however, is not likely to create that vision, so the task will be left to those providers who are bold enough to shape new models for healthcare delivery. » Continue reading “Technology as Gateway to Knowledge”

Leave a Comment

The Data Life Cycle

This year and most of next will likely be spent figuring out how to get EHR systems installed in hospitals and physician offices. Most of the organizations making this transition will be doing so as a reaction to the federal government’s incentives and penalties for not doing so. But there is a much bigger, long-range picture that should provide a framework useful to healthcare leaders. The meaningful use rules require providers to report quality measures to various agencies for analysis. Some of this will be used to determine whether or not the system is being used at all in order to manage incentive payments, especially in the beginning. Other data, some not even conceived of yet, can be used to help improve what we know about medicine and to develop best prevention and treatment practices. This diagram shows one way to look at the process (click to enlarge).

From "data" to "knowledge"

Today, at least in the US, we’re in the first quadrant in the lower left corner. Here, we are just entering the first round of data collection on a national level. In the next quadrant, data will be aggregated and studied for various purposes. Early on, the type of data collected will help determine compliance with meaningful use, and other quality reporting initiatives. In quadrants 1 and 2, it’s still data, or at best “information,” while quadrants 3 and 4 represent the process of learning from that information and then finding ways to transfer that knowledge into support systems that can improve point of care quality and value to both the patient and the healthcare system.

The interesting questions that must be addressed in order to accomplish this are at the heart of “The Art of Medicine and Technology,” and what we want to explore on this site. Some questions arise at each point along the cycle:

Quadrant 1:

  • What kind of data must we collect at this point in order to add value in Quadrant 4?
  • Are we collecting it now?
  • Will it require re-engineering systems?

Quadrant 2:

  • Who does this work?
  • Who has access to the data?
  • How do we ensure that the analysis is unbiased and adds to the art of medicine?
  • Are there any ethical issues involved in doing mass aggregation and analysis of health data?

Quadrant 3:

  • What do we want to learn?
  • Can technology help us uncover unanticipated discoveries?

Quadrant 4:

  • How will this knowledge translate to support systems?
  • Can we trust what we do?
  • Is it ethical to transfer knowledge “in progress” to computerized systems?
  • How many cycles are required before physicians move from trust to reliance on technology?

As always, your comments are welcomed!

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

Leave a Comment

Clinical Support Beyond the Interface

If one of the stated benefits of information technology is to support the physician’s decision making process, how will the physician’s role evolve as we increasingly come to rely on technology for support? This question assumes that we will continue to use technology to support, not replace the physician (or nurses or other clinicians for that matter). Until the time comes when we have managed to capture and represent all current medical knowledge through technology, the physician is likely to remain the primary observer; technology cannot yet take histories or connect the important dots within a complex personal narrative. Meanwhile, there will be new challenges that must be understood and managed; for example:

  • We must go deeper than the clinician-machine interface, and examine whether the data we currently collect is a capable foundation for a future of sophisticated analysis and support;
  • The concept of “interface” must evolve beyond the presentation of information and related input/response mechanisms to include clinical technology’s apparent cognitive process, so that it more closely complements clinical decision making;
  • Clinicians must take leadership roles in analyzing the current interface and describing what works and what doesn’t work;

Obviously,the art of medicine will increasingly include the ability to accurately describe the patient narrative to a technical support system in a format that can be processed not only for immediate patient benefit, but in a way that can be collected and analyzed in order to build medical knowledge and eventually, better quality of care for all. Physicians, nurses and other clinicians should be at the center of this movement.

Some questions:

  1. If you are a provider, what do current systems get right?
  2. What do they miss?
  3. In what ways do current EHR systems compromise your ability to provide quality care?

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

Leave a Comment